Knee osteoarthritis is not one condition with one treatment. It is a spectrum, and the single most useful thing a patient can know is which part of that spectrum their knee sits in. The stage decides the treatment far more than the severity of pain does.
Radiologists commonly grade it using the Kellgren-Lawrence system. What follows is what those grades mean in plain terms, and what each one usually calls for.
The X-ray is close to normal. There may be a tiny osteophyte, or a joint space that looks marginally reduced. Symptoms are intermittent: some stiffness after sitting, mild discomfort after unusual activity.
This stage needs education and load management, not medication. Quadriceps and hip abductor strengthening, sensible footwear, avoiding deep squatting and prolonged floor sitting, and weight optimisation where relevant. Most people at this stage do not need to see a surgeon again for years.
Definite osteophytes are present and joint space narrowing is visible. Pain is now reproducible: stairs, long walks, getting up from low seats.
Structured physiotherapy becomes central rather than optional. Short courses of analgesia for flares are reasonable. This is also the stage where a patient should understand that the aim is to keep the knee in stage two for as long as possible, which is realistic for many people.
Multiple osteophytes, definite joint space narrowing, some sclerosis and possible early deformity. Pain is now present during ordinary daily activity and often at rest after a heavy day. Walking distance is measurably reduced.
Treatment here is genuinely a discussion rather than a protocol. Physiotherapy still helps. Injections have a defined role. Some patients with predominantly single compartment disease and good ligaments may be candidates for partial knee replacement. Others do well non-surgically for several more years. The decision depends on how much the knee is limiting the life the patient wants to live.
Large osteophytes, marked joint space narrowing or bone-on-bone contact, sclerosis and clear deformity. Night pain, rest pain, a limp and significant loss of walking distance are common.
At this stage, non-surgical treatment manages symptoms but does not change the joint. Total knee replacement is the intervention that reliably restores function. Injections at this stage often give short and diminishing relief, which is worth knowing before spending money on repeated courses.
Pain and radiographic stage correlate poorly. Some people with stage two arthritis have a great deal of pain, usually because of inflammation, weakness or a coexisting problem such as a meniscal tear. Some people with stage four changes cope remarkably well.
This is why a treatment plan built only on how much it hurts today tends to be wrong. The plan should be built on the stage, the deformity, the ligament status, the patient's functional demands and their other medical conditions.
A stage-by-stage patient guide is available here: https://www.mayurajcc.com/knee-arthritis-guides/stages-of-knee-arthritis
Ask which stage your X-ray shows, whether the wear is in one compartment or all three, whether there is any deformity, and what the realistic aim of treatment is over the next two years.
A weight-bearing X-ray of both knees is the standard investigation. An MRI is rarely needed for staging osteoarthritis and is usually ordered only when a specific soft tissue question needs answering.
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